FIRE Logo Harvard Medical School Logo

Tuberculosis with hilar adenopathy

Kitt Shaffer, MD, PhD
Darrell Smith, MD

4/23/01

Presentation

This 43 year old female had noticed fevers to 100-101 daily for several weeks, and more recently has had drenching sweats at night that have left the sheets wet.

Imaging Technique

PA chest film, chest CT image in mid-chest, 10mm slice thickness. Look at the films and decide what you think is abnormal, and how it could relate to the patient's symptoms.

Imaging Findings

PA chest radiograph
CT image from mid-chest

The annotated chest film shows an outline of the abnormality, which is enlargement of the left hilum. It also shows the presence of a small left pleural effusion (compare left costophrenic angle to right). The hila of the lung are very difficult to analyze on radiographs because there is such a range of normal in terms of size and shape from one person to another. The left hilum is normally slightly higher than the right, but accounting for this, the overall bulk or size of the two hila should be similar. The annotated CT image shows the same asymmetry, indicating the presence of left hilar adenopathy.

Differential Diagnosis

lymphoma; tuberculosis; sarcoid

Diagnosis

tuberculosis with hilar adenopathy

Discussion

Adenopathy is one of the hallmarks of tuberculosis, although in adults it is not often evident on chest films. It occurs more often in primary tuberculosis in children. Adenopathy is quite uncommon in other types of pneumonia except in rare diseases such as tularemia or plague. When an infection is suspected and adenopathy is present, tuberculosis must be the first consideration. It must, however, be kept in mind that tumors can also produce fevers and night sweats, and lymphoma is famous for this. So lymphoma is also a major consideration.

References

Fraser and Pare's Diagnosis of Diseases of the Chest, 4th edition, Chapter 27-Mycobacteria, W.B. Saunders (1999).

To Visitors: Nothing on this website should be considered medical advice. Only your own doctor can help you make decisions about your medical care and it is not s Hospital, Dana-Farber Cancer Institute, or Harvard Medical School to offer consultation via the web at eduational sites such as these. s Hospital toll-free physician referral line at 1-800-294-9999.

Contact DNSMITH@PARTNERS.ORG for additional information about this site.